How and why weight stigma drives the obesity 'epidemic' and harms health.

A Janet Tomiyama, Deborah Carr, Ellen M Granberg, Brenda Major, Eric Robinson, Angelina R Sutin, Alexandra Brewis

Journal: BMC medicine 2018;16(1):123

PMID: 30107800

Free Full Text on BioMed Central View on PubMed

Plain Language Summary

Weight stigma is defined as the social rejection and devaluation that accrues to those who do not comply with prevailing social norms of adequate body weight and shape. In this opinion-based study, authors discuss that: • Latest literature indicates that weight stigma can trigger physiological and behavioural changes linked to poor metabolic health and increased weight gain. • Healthcare is a setting in which weight stigma is particularly pervasive, with significant consequences for the health of higher-weight patients. This stigma has direct and observable consequences for the quality and nature of services provided to those with obesity. • Stigma may be an unintended consequence of anti-obesity efforts, undermining their intended effect. Moreover, focusing solely on obesity treatment runs the risk of missing other diagnoses. • The science of weight stigma crystallizes a key point for future success – to tackle the obesity ‘epidemic’ we must tackle the parallel epidemic of weight stigma. • Public service messages are needed to educate people about the stigma, discrimination, and challenges facing higher-weight individuals. Authors conclude that to advance as an equal society, healthcare providers should lead the way for weight stigma eradication.

Abstract

BACKGROUND

In an era when obesity prevalence is high throughout much of the world, there is a correspondingly pervasive and strong culture of weight stigma. For example, representative studies show that some forms of weight discrimination are more prevalent even than discrimination based on race or ethnicity.

DISCUSSION

In this Opinion article, we review compelling evidence that weight stigma is harmful to health, over and above objective body mass index. Weight stigma is prospectively related to heightened mortality and other chronic diseases and conditions. Most ironically, it actually begets heightened risk of obesity through multiple obesogenic pathways. Weight stigma is particularly prevalent and detrimental in healthcare settings, with documented high levels of 'anti-fat' bias in healthcare providers, patients with obesity receiving poorer care and having worse outcomes, and medical students with obesity reporting high levels of alcohol and substance use to cope with internalized weight stigma. In terms of solutions, the most effective and ethical approaches should be aimed at changing the behaviors and attitudes of those who stigmatize, rather than towards the targets of weight stigma. Medical training must address weight bias, training healthcare professionals about how it is perpetuated and on its potentially harmful effects on their patients.

CONCLUSION

Weight stigma is likely to drive weight gain and poor health and thus should be eradicated. This effort can begin by training compassionate and knowledgeable healthcare providers who will deliver better care and ultimately lessen the negative effects of weight stigma.

Address: Department of Psychology, University of California Los Angeles, 1285 Franz Hall, Los Angeles, CA, 90095, USA. [email protected].; Department of Sociology, Boston University, Boston, MA, USA.; Department of Sociology, Anthropology, and Criminal Justice, Clemson University, Clemson, SC, USA.; Department of Psychological and Brain Sciences, University of California, Santa Barbara, CA, USA.; Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK.; Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, FL, USA.; School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, USA.

DOI: 10.1186/s12916-018-1116-5